Ryding 2004.

Methods	Design: RCT
Participants	Setting: hospital obstetrics and gynaecology department Type of trauma exposure: EmCS Inclusion criteria: all Swedish‐speaking women giving birth to a live infant by EmCS at the participating hospital Exclusion criteria: non‐Swedish speakers Sample size: 217 women met the inclusion criteria; 162 were randomised. Mean age: 32 (SD not specified) years, range 19–44 years Gender: 162 (100%) women Ethnicity: not specified Country: Sweden 162 women who had experienced birth by EmCS. Intervention offered to all.
Interventions	Group 1: group counselling: n = 89 4 or 5 women were invited to each of the EmCS groups. The group leaders were a maternity and child welfare psychologist and an experienced delivery ward midwife. Consultations lasted for 2 hours, and the groups met twice at a 2‐ to 3‐week interval. The main purpose was to arrange for participants to meet other women who had undergone EmCS so that they could share experiences. It was hoped that the women would be able to discuss both medical procedures (the midwife would have the answers) and psychological matters, such as feelings after a traumatic birth and feelings about motherhood and the baby (the psychologist would be able to provide counselling). It also hoped to identify new mothers in need of individual contact and to provide information about the possibilities of further help. Group 2: TAU: n = 73 Women offered an individual consultation to discuss their recent delivery, if they wished, after completing outcome questionnaires at 6 months' postpartum. Standard care after an EmCS included the midwife and doctor involved in the procedure visiting the mother in the maternity ward so as to exchange information about the experience, although for practical reasons this was not always possible.
Outcomes	PTSD: IES Other: Wijma Expectancy/Experience Questionnaire; EPDS Follow‐up: 6 months
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Women who gave birth on approximately 18 predetermined days of the month were randomised to the counselling group, and the remainder to the control group.
Allocation concealment (selection bias)	High risk	Women who gave birth on approximately 18 predetermined days of the month were randomised to the counselling group, and the remainder to the control group.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	All measures where self‐report which participants completed by post.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Analyses were based on the number of questionnaires returned. Response rate was high for both groups. Data were reported by median and interquartile range. The reason for this was unclear but may have been because of skew.
Selective reporting (reporting bias)	Unclear risk	No study protocol identified.
Other bias	Unclear risk	The group intervention was not manualised and was provided through semi‐structured delivery. Treatment adherence was not reported.